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Amid Improvements, Maricopa County Jail Medical Services Still Deficient

by Matt Clarke

Recent reports filed in a long-standing federal lawsuit against Sheriff Joe Arpaio over deficiencies in the medical and mental health care of prisoners in the Maricopa County jail system have cited both improvements and persistent deficiencies. Meanwhile, a little-known section in the new federal health care laws could speed up Justice Department investigations of jails and other institutions which are already the subject of an investigation under the Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. § 1997.

In April and August 2010, court-appointed medical expert Dr. Lambert King and mental health expert Dr. Kathryn Burns filed their sixth and seventh reports on the compliance of Maricopa County jails with the Second Amendment Judgment in a long-standing federal civil rights class-action suit. The suit alleged constitutionally insufficient medical and mental health treatment at the jails. The October 22, 2008, judgment ordered a variety of reforms in Correctional Health Services (CHS), which provides medical and mental health treatment at the jails, and improvements in those services. Subsequent orders in January 2009 appointed the experts.

"The CHS medical care program in the Maricopa County Jails was evidently substandard and troubled prior to Judge Wake's Order of January 28, 2009. This was no small problem, since CHS is responsible each year for the medical evaluation of more than 115,000 intake medical evaluations and a daily inmate population of over 7,200 men and women, many of whom have complex acute and chronic medical conditions. Moreover, CHS staffs six jails and nine health care locations in the NCJ system," said King, who acknowledged some improvement over the previous two years, but noted that the positions of Executive Director, Medical Director and Nursing Director had only been filled by qualified health care professionals within the preceding six months. Apparently at least some of these critical executive leadership positions at CHS had previously been filled by business experts, not health care professionals.

The report noted progress toward compliance but also the necessity for further improvements based upon a review of selected prisoners' medical records. One of the improvements noted in the jail system was a decline in the total mortality rate from an annual average of 152 per 100,000 prisoners in the three-year period of 2005-2007 to 61 per 100,000 prisoners in 2008-2010. However, the review of medical records showed persistent problems such as a failure by nurses to report critical medical information to physicians, a failure to consult medical records from previous jail incarcerations, delays in receiving medical tests ordered by physicians, large gaps in recorded medical treatment, and recurrent lapses in clinical and medication management of Coumadin therapy. The medical deficiencies discovered fall generally in several categories of delays in care and stabilization of newly-arrived prisoners, incomplete or incorrect nursing assessments, lack of timely communication from nurses to physicians and various medication errors such as giving the wrong medication or dosage, failure to give the medication and missing or incorrect documentation.

Dr. Burns noted that the most frequent Mental Health Unit (MHU) problem was inadequate outpatient follow-up after release to general population. Only 64% of the patients for whom a follow-up appointment was scheduled actually received a follow-up examination as scheduled. She also noted that many patients were being discharged from the MHU prematurely. There was also a lack of medical treatment space for prisoners who are intoxicated or undergoing withdrawal from drugs. 76% of the overall mental health medical records reviewed showed problems of some kind.

The audit also revealed the continuing inadequacy of initial admission assessments, including the assignment of incorrect triage codes. Despite the periodic disinfecting of surfaces, MHU cell inspections showed that "the floors, walls and windows appear grimy and stained with what appears to be dirt, feces and/or blood in some instances." Such an environment is neither therapeutic for the prisoners nor hygienic for staff or prisoners.

One improvement was the elimination of isolation as a step in suicide prevention. The average length of time it took for a prisoner to receive a psychiatric examination after one was ordered was 5.5 days, an improvement over the 7-day previous average. Psychotropic medication prescriptions were usually filled within a day of being ordered, but the rationale for why mediation was not necessary was frequently missing when medication was not prescribed and the delay in receiving a psychiatric examination meant that prisoners newly arriving at the jail had to wait about six days to receive their medication. Missed doses of medication continued to be a problem in 38% of the cases.

The reports made recommendations on how to improve medical and mental health treatment in the jail system. Hopefully these will lead to continued improvement in the care jail prisoners receive.

From the beginning of this lawsuit, Maricopa County Sheriff Joe Arpaio's position has been to resist reform and grandstand, painting the attempt to improve conditions in the jail system as politically motivated. He has claimed that federal investigators targeted him because of his conservative politics, not the jail conditions. He also asserted that U.S. Department of Justice (DOJ) lawyers posed as reporters to gain access to a news conference he held. The DOJ's Public Integrity Section has publicly criticized him for making misleading statements. Now, a new federal law may help speed up federal investigations of jail conditions under the Civil Rights of Institutionalized Persons Act of 1997 (CRIPA).

Under the new law, which was enacted as part of the sweeping reform of federal health care laws signed into law by President Obama in March 2010, the U.S. Attorney General may expedite subpoenas in any case in which an institution is subject to a CRIPA investigation. It is hoped that this new tool will speed up the snail's pace speed of CRIPA investigations.
"It's an important step because, under CRIPA, state governments do not have to cooperate," said American Civil Liberties Union's National Prison Project staff counsel Amy Fettig. "The most important thing that DOJ can do is show more leadership on [health care for prisoners in state prisons and jails]. It's a national disgrace and federal leaders should be investigating and calling for reform."

One can only hope that this call for federal leadership in the reform of state prison and jail health care is heeded. The past has made it abundantly apparent that local leaders, such as Sheriff Arpaio, will not be lining up to provide prisoners access to constitutionally-adequate health care on their own. See: Graves v. Arpaio, U.S.D.C. (D.Ariz.), Case No. 2:08-cv-00323-JAT-LOA, 2011 WL 2784810.


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Related legal case

Graves v. Arpaio